Raw Honey: Good for you, bad for your baby

A look at the risks posed to infants by local, unprocessed honey. Try local honey if you have allergies.

Spring and summer months see an increase in the consumption of local honey. Honey is widely known to be an excellent, natural, way to treat seasonal allergies and many doctors suggest it as a first treatment in mild cases, before prescribing antihistamines. Honey can also be used to treat skin wounds that are slow to heal. However, lurking in every jar of unprocessed honey, and for honey to help allergies it needs to be unprocessed, are the spores of bacteria that under the right circumstances can lead to a potentially life threatening condition called “Floppy Baby Syndrome” or Infant botulism.

Our intestinal bacteria protect us from pathogens.

Recently, I published an article (Probiotics: A simple food from your refrigerator that stops diarrhea, 11 June 2013) about diarrhea that sometimes occurs while taking broad spectrum antibiotics. One of the leading organisms for causing this kind of diarrhea is Clostridium difficile. Often when a person is taking a broad spectrum antibiotic the medicine will seriously reduce the number of naturally occurring bacteria that live in the human digest tract. If we inadvertently ingest spores of C. difficile the organism will begin to grow in our intestines and without our normally protective bacterial fauna. C. difficile will begin to release toxins that cause enteritis, a common symptom of which is diarrhea. As the C. difficile numbers increase the symptoms get worse and worse. The symptoms continue until your normal intestinal bacteria begin to recover and eventually overwhelmed the invading C. difficile. To speed the recovery or prevent the condition altogether, doctors often recommend consuming probiotics foods that contain living bacteria, such as yogurt, while taking broad spectrum antibiotics.

Why is local or unprocessed honey a risk?

The risk of unprocessed honey is that the honey often contains the spores of another member of the Clostridium family of bacteria. In this case, the bacteria is much more deadly, it is the bacteria that causes botulism and the botulinum neurotoxin is the most powerful toxic substance known. When honey is process, the treatment kills these spores as well as fungal spores and spores from other bacteria; therefore, properly processed honey is not a risk.

Why is local honey not a risk to adults?

As mentioned above, adults have a mature, stable bacterial population living in their digestive tract. These bacteria can be considered territorial and are generally unwilling to let invading bacteria grow and prosper. This is one of the very important benefits we get from our intestinal bacteria. Therefore, when spores of C. botulinum arrive, they discover that the indigenous bacteria are quite hostile and have no intention of allowing colonization by an interloper.

Why is local honey a risk to infants?

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It turns out that the digestive tract of an infant (less than 1 year, 90% of case are in infants less than 6 months) is very similar to the digestive tract of an adult taking a broad spectrum antibiotic. Both have much reduced numbers of naturally occurring bacteria. In the case of the infant, the cause is a natural; infants simply haven’t lived long enough to be completely colonized by friendly bacteria. However, by age one, the bacterial colonization process is complete and the child is no longer at risk. Without a healthy, mature intestinal bacteria population, spores of C. botulism that may be present in honey, will pass through the stomach and enter the infant’s intestines. With no competing bacteria to contend with, the C. botulism colony increases in numbers and begin to release the botulism neurotoxin. When this happens the infant will start showing signs of botulism intoxication. Since the botulinum toxin is a neurotoxin, the symptoms take the form of muscle paralysis or extreme muscle weakness, and the infant appears to lose their muscle tone, which is why the condition is often called ‘floppy baby syndrome’ instead of Infant Botulism.

The intoxication is a medical emergency but with rapid, aggressive intervention infants usually recover. Nonetheless, infant botulism, the most common form of botulism, kills about one hundred infants each year. In addition to the skeletal muscles the neurotoxin also targets the diaphragm. If the diaphragm is paralyzed then the infant suffocates. It is believed that up to 5% of cases of ‘crib death’ or ‘sudden infant death syndrome’ are caused by C. botulism intoxication.

Is local honey the only risk?

Local honey is the most likely food product to which an infant might be exposed. It is tempting to dip a finger into honey and offer it has a treat to an infant. However, honey is not the only risk. Clostridium botulism spores are found through the natural environment, especially in soil and dirt. Many cases have been reported in areas where the soil has recently been disturbed.

People and pets can easily carry the spores into the indoor environment on their shoes or feet. Since infants are extremely oral and like putting things in their mouth, it is easy for contaminated objects to cause infections. Clearly it is best to make sure that infants are not on the floor, unless they are on a clean blanket. Afterwards the blanket must be washed before it can be used again for the infant.

The overall risk is low, nonetheless, some simple precautions are wise:

• Don’t feed unprocessed honey to an infant,
• Don’t put an infant on the floor, unless on a clean blanket, sheet or towel,
• Don’t let infants put things off the floor into their mouth and
• Don’t let dog or cats be affectionate towards an infant. It may look cute for the family dog to lick an infant, but remember, the dog licks lots of other things.
• If an infant is prescribed antibiotics, you should be extra careful. The antibiotics used to treat a pathogen, may decimate the intestinal bacteria in the infants intestines. This would most likely present as enteritis, but it could make the infant even more susceptible to C. botulism intoxication.

After a 12 months, the child will have a happy, healthy colon full of bacteria and will be protected from many environment pathogens, including routine, if inadvertent, contact with C. botulism and C. difficile spores.

Treatment
Infant botulism cannot be treated at home and requires urgent medical attention.

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